What kind of work are you involved in?
I worked in Kenya for most of my life. I came to South Africa to pursue my Ph.D. Just a month ago, I successfully completed my studies. I am a dietician by training, and I have also been involved in nutrition education. From partnering with corporate organizations to speaking on TV, the work I do encompasses nutrition and health education to individuals, public, and worksite wellness. The end goal is to create nutritional awareness, especially around obesity and metabolic syndrome, as well as related risk factors.
How did you get started in this field?
Originally, I wanted to be a doctor, but I didn’t qualify to study medicine in Kenya. One of my uncles encouraged me to pursue a career in nutrition. I studied nutrition and dietetics in university before joining the workforce full swing – finding an internship and working in a hospital environment. Afterwards, I also began working on public health in an education capacity.
What would you say are some of the issues surrounding cardiovascular health and obesity in Kenya and South Africa?
These are growing health concerns, but there is far more funding being directed to Malaria, Tuberculosis, HIV/AIDS, and malnutrition in children under five years. Less funding is available for obesity and non-communicable disease prevention even though obesity is a major problem globally. And of course, obesity leads to diabetes, so behind the obesity epidemic, there is the diabetes epidemic, the hypertension epidemic, etc.
Most governments, especially in African countries have neither the capacity nor the workforce to deal with this issue. However, if they don’t do anything now, they won’t be able to manage it in the future.
What are some misconceptions that the public holds about these diseases?
Once considered a high-income country problem, overweight and obesity are now on the rise in low and middle-income countries, particularly in urban settings. Also, one long held perception is that obesity and other cardiovascular diseases have been associated with high-income populations is not true, because these conditions are found all over the socio-economic spectrum. In fact, there are studies that suggest that in houses with malnourished children, there is likely to be an obese adult, doubling the burden of disease.
What advice would you give to kids to prevent cardiovascular diseases?
Some kids are probably too young to be responsible for their diets, so in truth this falls to the parents. I would tell parents, “Don’t give your children diabetes, high blood pressure, or obesity in the future.” It means that if parents don’t manage their kids’ diet now – they’re giving them sugar-sweetened beverages, junk food, or allowing them to eat whatever they want – then they are in fact putting their children at risk for developing these conditions in 5-10 years. They should be thinking, “Am I giving my child cardiovascular disease? Is that what I am investing in their future?”
Would you weigh exercise or nutrition heavier in terms of prevention?
Both are important, but most studies show that your diet is 80% of the battle and exercise is 20%. Diet plays a really big role because whatever you eat affects you in the near future. One of my favorite sayings is “your genes load the gun, but your lifestyle pulls the trigger.”
How do you see these health issues affecting women?
Women are affected the most. I have found in my career that this is because women take care of the family, take care of their husbands, take care of their children, and they don’t have time to take care of themselves. Generally, moms don’t have time to look after their health or exercise until their children are older, and by that point, they are already overweight, diabetic, and hypertensive. Women must take pre-emptive steps and start taking care of themselves earlier. More campaigns are needed to emphasize this. “When you teach women, you teach the whole village.”
We need to help women more. I remember one time going to see one of the top cardiologists in Nairobi. He told me to go out and count the number of men and women in the waiting room area. There were probably about 18 women seated, only two of whom were brought by their spouses. The rest had come on their own. The doctor was telling me, “Alice, please, you need to do something to educate these women. I’m only seeing them in their 40’s when they already have problems because they don’t come early for prevention’s sake.” So as a nutritionist and dietetic consultant, I need to work on increasing awareness and health education targeting women and girls. The same is required of other public health professionals.
These health problems will affect women economically as well later on. If at 40 they want to change careers, they can’t leverage their experience and knowledge due to health issues. When they are 40 and already obese, diabetic, or hypertensive, finding and retaining jobs may be difficult if they are in debt or take too many sick days off. So in addition to poor health career advancement may be limited as a result of these conditions.
What would you say are some policy recommendations for the governments of Kenya and South Africa to help resolve this issue?
Existing policies should be strengthened to target different populations. Policies should say women are being targeted for obesity prevention or women are being targeted for diabetes prevention, because women’s health and men’s health involve entirely different psychologies and socio-economic factors.
Additionally, there should be policies that make prevention practices and health promotion mandatory in every district and in every hospital. Health facilities should conduct mess aging campaigns advocating, for example, weight loss for disease prevention. Hospitals should provide patients with information about their clinical conditions, along with information about their diet and actions necessary to prevent conditions such as obesity and diabetes in the future.
Every employer should budget for health promotion activities in the workplace. Experience has shown that when businesses acquire group health insurance for employees, there is often limited resources for nutrition support and education. In Kenya, most Health Management Organizations include nutrition as an exclusion. What that means is that if you want to get nutrition education advice, you have to pay for it yourself, and most of the time people don’t want to pay for nutrition. Reason being, nutrition gives you information; it doesn’t give you medicine or a prescription. Most people would rather go to the doctor because they will at least receive either medicine or a prescription. This is a big challenge for the work of nutritionists and how we package information, health behaviors, and actions to produce results. The array of actions necessary to address this issue includes policies requiring the inclusion of nutrition in workplace insurance plans.
Which women inspire you, whether in your field or your personal life?
Big question. The first woman I can point to is my mother. She has passed away, but she was a go-getter and always inspired me. She was a giver, and a very hard working woman. She gave her time, her resources, and practically everything she had to help her family, neighbors, friends, and the whole village.
Even though my mother only finished elementary school and had problems reading herself, she made us read. She worked very hard when my father abandoned the family to make sure that we stayed in school and there was food on the table. Through her strength and resolve, my mother showed me that a woman can work while still taking care of her family, no matter what. I can say without a doubt that my work ethic comes from my mother. She taught me to be generous with everything I have. Because of her example I find pleasure in mentoring young ones and sharing my experience and resources to develop those around me. She taught me to “never give up” no matter how grave the situation is.
Another woman who inspires me is one of my close associates Regina Kiluva. She has been a mentor to me and is a very honest and hardworking person. Regina tells you things as she sees them, whether you like it or not. From Regina, I learned that if you take counsel and corrections, you will grow personally and professionally. You will thrive in your career. There is no growth without support from other professional colleagues.
In fact, many people, both men and women, have played important roles in my life and at different stages of my life. “It takes a village.”